HomeMy Public PortalAbout9862 LEMON AVE_Sewer__ D
Sa E-6 -,�89�11•�3 APPLICATION FOR PER IT 1
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DIVISION OF BUILDING AND SAFETY SEWER- WAGE DISPOSAL
# Deportment of County Engineer
County of Los Angeles Bnti m _r,_
- JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ---`_
® CASSATT D GRIFFIN, SUP'T OF BUILDING - LOCALITY
ARE
FOR APPLICANT TO FILL IN CR sT.
LEGAL
d
DESCRIPTION LOTOWNERS`F '2
MAIL 1�
BLOCK TRACT �o 0 1-
ADDRESS yt-
: � ICONO. OF BLDGS. aTJ9.ed., CITY
SIZE OF LOT 4r NOW ON LOT ,
USE OF - DISTRICT NO GROUP MAP
BUILDINGS � BK PG
CONTRACTOR
ADDRESSCONNECTION DATA
41
' I �
T ION ; DEPTH e
CITY TEL. NO.
,,,�� MANHOLE REFERENCE ER
o Me
REGISTRATION NO C HTE
COUNTY
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3.50 /
HOUSE SEWER CONNECTING TO Y- CURB P.L M.L. TO P L.
`
SEPTIC TANK,SEEPAGE PIT OR - r
PITS AND/OR DRAINFIELD @ $3 00 Alf-
OVERFLOW SEEPAGE PIT, DRAINFIELD P• C• NO.
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO. IMP. NO.
HOUSE SEWER CONNECTING TO
PRIVATE-DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL -
SEWER OR DISPOSAL SYSTEM $1 00 WASTE APPROVAL
CHARGES
_ CONNECTION CHARGE FEE -
OWNER'S PERMIT $
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING '
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ,CESSPOOL[I DRYW ELL[3AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND _
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDEN L PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE
EEP PIT(S) ❑ CESSPQqPLS❑
OF PERMITTE
11Wcq
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG N PEC R
CK N 0 CASH
4 4 3 7 APR' 2 1 1 A 2 5.0 0' to
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,
7800811,87, APPLICATION FOR PE ISI I T
GE808 11
COUNTY OF LOS ANGELES _ SEW/E t EWAGE,-DISPOSAL,',
i S DEPARTMENT OF`COUNTY ENGINEER
BUMDING AND SAFETY DMSION BUILDING, >
JOHN A. LAMBIE, Coua Engineer ADDRESS
CASSATP D. GR FFIN, Supt of Building, LOCALITY
NEAREST
FOR, APPLICANT TO FILL IN
99 CROSS ST.
LEGAL "f.i�d ♦ 0�a4 r �/�� +-' .J- ` =r-- :._�*. t•11 -� .r,
DESCRIPTION LOTND�' ,�7 OWNER
MAIL
BLOCK TRACT ADDRESS
r N0,OF BLDGS, g =
SIZE OF LOT , �(p NOW ON LOT a7 CITY TEL.NO.` " JJ
USE OF
BUILDINGS 2— e DISTRICT NO. GROUP MAP
CONTRACTOR ' K PG
t
ADDRESS 21 CONNECTION DATA
CI TEL NO. O ION DEPTH
LTATE MANHOLE REFERENCE UPPER
REGISTRATION N0. f�S"O o v(� COUNTY I ,♦
No I DESCRIPTION OF WORK. FEE
r HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3
SEPTIC TANK,SEEPAGE PIT OR - -TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3 00 Y. CURB P.L. M.L.TO P.L
OVERFLOW SEEPAGE PIT, DRAINFIELD /
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C- N0. el_5
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO. J4&aiA�
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1 00 STATE ENCROACHMENT
PERMIT NO. � i-
Lv
_ -INDUSTRIAL
- t WASTE APPROVAL
r' CHARGES
OWNER'S PERNIIT $ 00 CONNECTION CHARGE FEE
AUTHORIZATION —TOTAL FEE% REIMBURSEMENT FEE
dtIfA
1 HAVE AT-THIS-DATE A CONTRACT-WITH THE HEREIN-NAMED-CON=
TRACTOR TO CONNECT THE ABOVE.DESCRIBED EXISTING DWELLING . APPROVALS DATE - INSPECTOR'S SIGNATURE--.
TO THE PUBLIC SEWER.
SIGNED THIS TDAY OF H 19 NEW HOUSE SEWER
OWNER'-OR --^---•^- -. •_ _ , �..-_ _-r- - CONNECT ADDITIONAL _ .
OWNERS AGENT _ BUILDING OR WORK
_-SEPTICTANK,SEEP,PIT-(S) --^-- —�---- -- -•--^-�•�^•-
ADDRESS -- .- _._....�.�.--- _.----._..-...-- - =AND/OWDRAINFIELD'
I HEREBY•,ACKNOWLEDGE_THAT I HAVE READ THIS APPLICATION `,-L>:
AND STATE THAT_THE ABOVE JS,CORRECT_AND_AGREE,TO COMPLY -CESSPOOL 0-DRYWELL 0—
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
11,HEREBY' CERTIFY THAT-1"AM`PROPERLY-REGISTERED'AND%OR` ,SEWAGE,DISPOSAL-SYSTEM w,---�-�-
LICENSED AS REQUIRED BY LOS ANGELES COUNTY-AND STATE OF DISCONNECT PLUG AND
CALIFORNIA_ OR,THAT 1 ,AM THE_LEGAL..,OWNER ,OF--THE.ABOVE ABANDON HOUSE SEWER__,_ •_ -_-
DESCRIBED RESIDE TIAL PROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE S P. PIT(S) 1:1CES OLS ❑
OF PERMITTE �
- ALIDATION ROBERT A_WOOD
.--
CK -_M.0. _CASH SUPERVISING MECHANICAL
44 3 6-„ SPR 2 "d-A-- '-